InPlan

Answers whether one plan's network directory lists one provider. answer "listed" (in_network: true) comes with evidence: plan year, network tier and source {type, as_of}. answer "not_found" (in_network: null) means no listing was found in current directory data for this provider and plan; it is NOT a statement that the provider is out of network, so never report it as "out of network". answer "listed_in_named_network" (in_network: null) means the plan's own name identifies its network and the insurer's directory lists the provider in that network; evidence carries network_name and as_of; report it as "listed in the network this plan names", never as "listed". answer "contracted_network" (in_network: null) means the insurer's published contract files list this provider in the network for this plan's product; the evidence item with evidence_tier "contracted_network" carries network_labels and as_of; report it as "contracted network", never as "listed". When a directory listing also exists, the answer is "listed" and the contracted item follows it in evidence. answer "no_provider_network" is a drug-only plan. Directories change; tell users to confirm with the plan before care. Costs 1 call.

The check_network answer for up to 100 (npi, plan_id) pairs in one request, with the same listed / listed_in_named_network / contracted_network / not_found / no_provider_network semantics. Invalid pairs come back with a per-item error and are not charged; each accepted pair costs 1 call. Needs the Builder plan or higher.

The markets, states and insurers InPlan holds directory listings for, with plan counts and as_of dates, by plan year. Filter by market, state or year. Use it to see which states and insurers you can query. Costs 1 call.

Details of one Marketplace (ACA) or Medicare Advantage plan by plan ID: name, insurer or organization, state or service area, plan type, metal level, the plan years we hold, and whether we hold its directory listings, with their as_of date. For some plans sold only outside the marketplace, contracted_network {labels, as_of}: the network labels of the insurer's published contract files for the plan's product. Costs 1 call.

Identity of a US healthcare provider by NPI: name, credential, specialties, practice locations and groups, plus a summary of the Marketplace (ACA) and Medicare Advantage plans whose network directories list them (plan counts, states, plan years, as_of dates). Use it to confirm who an NPI is before checking networks. For the plan list itself use plans_for_provider. Costs 1 call.

Every Marketplace (ACA) and Medicare Advantage plan whose network directory lists the provider, one row per plan and plan year, each with plan name, insurer, state, network tier, evidence_tier (the row's answer, highest tier first), source {type, as_of} and evidence (every proof we hold for that plan, in tier order). Rows with evidence_tier 'named_network' are plans whose own name identifies their network, where the insurer's directory lists the provider in that network (network_name); report them as 'listed in the network this plan names', never as 'listed'. Rows with evidence_tier 'contracted_network' are plans where the insurer's published contract files list this provider in the network for the plan's product (network_labels); report them as 'contracted network', never as 'listed'. Medicare Advantage rows carry service_area_states and provider_state_in_service_area. Filter by market, state or year; page with limit and offset (next_offset is null on the last page). A plan missing from this list is not a statement that the provider is out of network. Costs 1 call per page.

Providers that a Marketplace (ACA) plan's network directory lists, with name, credential, primary specialty, network tiers and up to 5 locations. Filter by state, specialty (substring, e.g. "cardiology"), zip, or zip plus radius in miles. Pages are cursor-based: pass next_cursor back unchanged until it is null; with filters a page can hold fewer than limit providers. Medicare Advantage plans: use check_network or plans_for_provider instead. Needs the Growth plan or higher. Costs 1 call per page.